Chapter 7 Experiential Family Therapy Family Therapy as an Emotional Encounter Learning Outcomes · Describe the evolution of experiential family therapy

Subject:BusinessPrice: Bought3

Share With

Chapter 7 Experiential Family Therapy

Family Therapy as an Emotional Encounter

Learning Outcomes

· Describe the evolution of experiential family therapy.

· Describe the main tenets of experiential family therapy.

· Describe healthy and unhealthy family development from an experiential perspective.

· Describe the clinical goals and the conditions necessary for meeting those goals from an experiential perspective.

· Discuss and demonstrate the assessment and intervention techniques of experiential family therapy.

· Discuss research support for experiential family therapy.

An experiential branch of family therapy emerged from the humanistic wing of psychology that, like the expressive therapies that inspired it, emphasized immediate, here-and-now experience. Experiential therapy was popular when family therapy was young, when therapists talked about systems but borrowed their techniques from individual and group therapies. From Gestalt therapy and encounter groups came techniques like role-playing and emotional confrontation, while other expressive methods such as family sculpting and family drawing bore the influence of the arts and of psychodrama. In focusing more on emotional experience than on the dynamics of interaction, experiential therapists seemed out of step with the rest of family therapy. Indeed, by emphasizing individuals and their feelings, experiential treatment may never have been as well suited to family therapy as were approaches that dealt with systems and interaction. With the passing of the inspirational leaders of this tradition, Virginia Satir and Carl Whitaker, the methods they popularized began to seem a little dated, more a product of the 1960s than of today’s world. Recently, however, experiential approaches have been enjoying a revival and, as we will see, two of the newer models—Johnson’s (2004) emotionally focused couples therapy and the internal family systems model (Schwartz, 1995)—have combined the emotional impact of an experiential focus on the individual with a more sophisticated understanding of family systems. As the first great cathartic therapist, Sigmund Freud, discovered, getting in touch with painful feelings is not by itself a complete form of psychotherapy. On the other hand, ignoring or rationalizing unhappy emotions may cheat clients out of the opportunity to get to the heart of their problems. Thus the experiential emphasis on emotional expression may be a useful counterweight to the reductionistic emphasis on behavior and cognition in today’s problem-solving approaches.

Sketches of Leading Figures

Two giants stand out in the development of experiential family therapy: Carl Whitaker and Virginia Satir. Whitaker was the leading exponent of a freewheeling, intuitive approach aimed at puncturing pretense and liberating family members to be themselves. He was among the first to do psychotherapy with families, and although he was considered a maverick, he eventually became one of the most admired therapists in the field. Iconoclastic, even outrageous at times, Whitaker nevertheless retained the respect of the family therapy establishment. He may have been their Puck, but he was one of them. Whitaker grew up on a dairy farm in upstate New York. Rural isolation bred a certain shyness but also conditioned him to be less bound by social convention. After medical school and a residency in obstetrics and gynecology, Whitaker went into psychiatry, where he became fascinated by the psychotic mind. Unfortunately—or fortunately—back in the 1940s Whitaker couldn’t rely on antipsychotic drugs to blunt the hallucinatory imaginings of his patients; instead, he listened and learned to understand thoughts crazy but human, thoughts most of us usually keep buried. After working at the University of Louisville College of Medicine and the Oakridge Hospital, Whitaker accepted the chair of Emory University’s Department of Psychiatry, where he remained from 1946 to 1955. Then, in the face of mounting pressure to make the department more psychoanalytic, Whitaker and his entire faculty, including Thomas Malone, John Warkentin, and Richard Felder, resigned to establish the Atlanta Psychiatric Clinic. Experiential psychotherapy was born of this union, and the group produced a number of provocative and challenging papers (Whitaker & Malone, 1953). In 1965 Whitaker moved to the University of Wisconsin Medical School. After his retirement in the late 1980s, he traveled widely to share his wisdom and experience at conventions and workshops. He died in 1995. Among Whitaker’s best-known students are Augustus Napier, now in private practice in Atlanta; and David Keith, at the State University of New York in Syracuse. The other towering figure among experiential family therapists was Virginia Satir. As an early member of the Mental Research Institute (MRI), Satir emphasized communication (see Chapters 1 and 5) as well as emotional experiencing. Satir began seeing families in private practice in Chicago in 1951. In 1955 she was invited to set up a training program for residents at the Illinois State Psychiatric Institute (where one of her students was Ivan Boszormenyi-Nagy). In 1959 Don Jackson invited her to join him at MRI, where Satir became the first director of training. She remained until 1966, when she left to become the director of the Esalen Institute in Big Sur, California. Satir was the archetypal nurturing therapist in a field enamored with abstract concepts and strategic maneuvers. Her warmth and genuineness gave her tremendous appeal as she traveled the country giving demonstrations and workshops. Her ability to move audiences made her family therapy’s most celebrated humanist. Satir died of pancreatic cancer in 1988.Among the most recent experiential approaches is emotionally focused couples therapy, which draws on Perls, Satir, Bowlby’s attachment theory, and the MRI group (Greenberg & Johnson, 1985, 1986, 2010; Johnson, 2004). Susan Johnson has emerged as this main proponent of the model. Another specialized approach to the emotional life of families is Schwartz’s (1995) internal family systems therapy, in which clients’ conflicting inner voices are personified as “parts” and then reintegrated using a variety of psychodramatic techniques.

Theoretical Formulations

Experiential family therapy is founded on the premise that the root cause of family problems is emotional suppression. Although children must learn that they can’t always do whatever they feel like doing, many parents have an unfortunate tendency to confuse the instrumental and expressive functions of emotion. They try to regulate their children’s actions by controlling their feelings. As a result, children learn to blunt their emotional experience to avoid criticism. Although this process is more or less universal, dysfunctional families tend to be less tolerant of unruly emotions than most. Children in such families often grow up estranged from themselves and feeling only the residues of repressed affect: boredom, apathy, and anxiety. While systemic therapists see the roots of symptomatic behavior in the dance of family interactions, experientialists view those interactions as the result of family members’ shadow dancing with the projections of each other’s defenses. From this perspective, attempts to bring about positive change in families are more likely to be successful if family members first get in touch with their real feelings—their hopes and desires as well as their fears and anxieties. Thus, experiential family therapy works from the inside out, helping individuals uncover their honest emotions, and then forging more genuine family ties out of this enhanced authenticity. The exception to the experiential de-emphasis on theory is emotionally focused couples therapy, which draws on attachment theory (Bowlby, 1969). According to Greenberg and Johnson (2010), emotion organizes attachment responses and serves a communicative function in relationships. When people express their vulnerability directly, they’re likely to elicit a compassionate response from their partners. But when an insecurely attached person fears vulnerability and shows anger instead, the response is more likely to be withdrawal. Thus the person most in need of attachment may, by being afraid to expose that need, push away the loved ones he or she longs to get close to. The antidote for this dilemma is what experiential therapy is all about: helping people relax defensive fears so that deeper and more genuine emotions can emerge.

Family Dynamics

In focusing on the importance of honest emotional experience and expression, the experientialists offered a useful corrective to the original family therapists’ narrow focus on behavioral interaction. This same corrective influence is relevant today, in the field’s narrow emphasis on biology and cognition. Normal Family Functioning Experiential therapists share the humanistic faith in the natural wisdom of honest emotion. According to this point of view, if people are allowed to follow their own instincts they tend to flourish. Problems arise because this innate tendency toward self-actualization (Rogers, 1951) runs afoul of social pressures. Society enforces repression to tame people’s instincts and make them fit for group living. Unhappily, self-control is achieved at the cost of “surplus repression” (Marcuse, 1955). Families add their own controls to achieve peace and quiet, perpetuating family myths (Gehrke & Kirschenbaum, 1967) and relying on mystification (Laing, 1967) to alienate children from their experience. In the ideal situation, parental control isn’t excessive, and children grow up in an atmosphere of support for their feelings and creative impulses. Parents appreciate their children, accept their feelings, and validate their experience. Children are encouraged to experience life fully and to express the full range of human emotions. Experiential therapists describe the family as a place of sharing experience (Satir, 1972). Functional families are secure enough to support and encourage a wide range of experiencing; dysfunctional families are frightened and bloodless. Neither problem-solving skills nor particular family structures are considered as important as nurturing spontaneous experiencing. In short, the healthy family offers its members the freedom to be themselves. Development of Behavior Disorders From an experiential perspective, denial of impulses and suppression of feeling are the root of family problems. Dysfunctional families are locked into self-protection and avoidance (Kaplan & Kaplan, 1978). In Harry Stack Sullivan’s (1953) terms, they seek security rather than satisfaction. Their presenting complaints are many, but the basic problem is that they smother emotion and desire. According to Whitaker (Whitaker & Keith, 1981), there’s no such thing as a marriage—only two scapegoats sent out by their families to perpetuate themselves. Together they must work out the inherent conflict in this situation. Couples who remain together eventually reach some kind of accommodation. Whether based on compromise or resignation, reconciling themselves to each other lessens the friction. Dysfunctional families, fearful of conflict, adhere rigidly to the rituals that they establish. Having experienced the anxiety of uncertainty, they now cling to their routines. In her portrayal of troubled families, Satir (1972) emphasized the atmosphere of emotional deadness. Such families are cold; they seem to stay together only out of habit or duty. The adults find their children annoying, and the children learn not to respect themselves or care about their parents. In consequence of the lack of warmth in the family, people avoid each other and preoccupy themselves with work and other distractions. It’s important to notice that the dysfunction Satir described isn’t the kind found in diagnostic manuals. Like others in the experiential camp, Satir was as concerned with normal people who lead lives of quiet desperation as with the officially recognized patients families usually focus on. As she (Satir, 1972) put it, It is a sad experience for me to be with these families. I see the hopelessness, the helplessness, the loneliness. I see the bravery of people trying to cover up—a bravery that can still bellow or nag or whine at each other. Others no longer care. These people go on year after year, enduring misery themselves or in their desperation, inflicting it on others. (p. 12) Satir stressed the role of destructive communication in smothering feeling and said that there were four dishonest ways people communicate: blaming, placating, being irrelevant, and being super reasonable. What’s behind these patterns of inauthentic communication? Low self-esteem. If people feel bad about themselves, it’s hard to tell the truth about their own feelings—and threatening to hear what others feel. A healthy relationship, according to Susan Johnson, is a secure attachment bond—that is, one characterized by emotional accessibility and responsiveness (Johnson & Denton, 2002). Secure attachment refers both to having grown up with a sense of being loved and to the confidence that comes from having a dependable intimate relationship. But when attachment security is threatened, people typically respond with anger—a protest that, unfortunately, may drive the other person away rather than evoke the desired responsiveness. Recently, Johnson (2004) has introduced the notion of attachment injuries: traumatic occurrences that damage the bond between partners and, if not resolved, maintain negative cycles and attachment insecurities (Johnson, 2004).

Mechanisms of Change

There are two unique aspects of the experiential perspective on change. The first is an emphasis on challenging emotional defenses. In this model, it might be said that the customer is always wrong—in the sense that family members often don’t know what they really feel. This leads directly to the second distinguishing characteristic of this approach, which is that experientialists tend to be fairly aggressive in attacking defenses to promote emotional expression. Goals of Therapy Experientialists emphasize the feeling side of human nature: creativity, spontaneity, and emotional honesty—and, in therapy, the value of emotional experience for its own sake. Emotional expression from family members is thought to break down rigid expectancies and unblock awareness—all of which promotes individuation (Kaplan & Kaplan, 1978). Bunny and Fred Duhl (1981) speak of their goals as a heightened sense of competence, well-being, and self-esteem. In emphasizing self-esteem, the Duhls echo Satir (1964), who believed that low self-esteem and the destructive communication responsible for it were the main problems in unhappy families. Whitaker (1976a) thought that families come to treatment because they’re unable to be close and therefore unable to individuate. By helping family members recover their own potential for experiencing, he believed that he was also helping them recover their ability to care for one another. Conditions for Behavior Change Among the misconceptions of those new to family therapy is that families are fragile and therapists must be careful to avoid breaking them. A little experience teaches the opposite: Effective treatment requires powerful interventions—and for experiential family therapists that power comes from emotional experiencing. Gus Napier (Napier & Whitaker, 1978) wrote, in The Family Crucible, a nice description of what experiential therapists think causes change. Breakthroughs occur when family members risk being “more separate, divergent, even angrier” as well as “when they risk being closer and more intimate.” To help clients take those risks, experiential therapists are alternately provocative and warmly supportive. This permits family members to drop their protective defenses and open up to each other. Existential encounter is believed to be the essential force in the psychotherapeutic process (Kempler, 1973; Whitaker, 1976a). These encounters must be reciprocal; instead of hiding behind a professional role, the therapist must be a genuine person who catalyzes change using his or her personal impact on families. As Kempler (1968) said: In this approach the therapist becomes a family member during the interviews, participating as fully as he is able, hopefully available for appreciation and criticism as well as he is able to dispense it. He laughs, cries and rages. He feels and shares his embarrassments, confusions and helplessness. (p. 97)For Satir, caring and acceptance were the keys to helping people open up to experience, and to each other: Some therapists think people come into therapy not wanting to be changed; I don’t think that’s true. They don’t think they can change. Going into some new, unfamiliar place is a scary thing. When I first begin to work with someone, I am not interested in changing them. I am interested in finding their rhythms, being able to join with them, and helping them go inside to those scary places. Resistance is mainly the fear of going somewhere you have not been. (quoted in Simon, 1989, pp. 38–39)

Therapy Experiential family therapists share the humanistic belief that people are naturally resourceful and, if left to their own devices, will be creative, loving, and productive (Rogers, 1951). The task of therapy is therefore seen as unblocking defenses and releasing people’s innate vitality. Assessment Because experientialists are less interested in solving problems than in enhancing family functioning, they pay limited attention to the specifics of the presenting problem. Moreover, because they focus on individuals and their experience, they have little interest in the structure of family organization. For most experientialists, assessment takes place informally as the therapist gets to know a family. In the process of developing a relationship, the therapist learns what kind of people he or she is dealing with. Whitaker began by asking each family member to describe the family and how it works. In this way, he got a composite picture of individual family members and their perceptions of the family group. This kind of inquiry is about as formal as most experiential therapists get in sizing up families. The majority of what serves as assessment in this approach is an attempt to decode the defenses that emerge in the ongoing course of trying to help family members open up to each other. Watch this video of an experiential therapist provoking a couple into a healthier interaction. What is your reaction to experiential therapy? Therapeutic Techniques In experiential therapy, according to Kempler (1968), there are no techniques, only people. This epigram neatly summarizes the faith in the curative power of the therapist’s personality. It isn’t so much what therapists do that matters, but who they are. However, this point is at least partly rhetorical. Whoever they are, therapists must also do something. Even if what they do isn’t planned, it can nevertheless be described. Moreover, experiential therapists tend to do a lot; they’re highly active and some (including Kempler) use a number of evocative techniques. Some use structured devices such as family sculpting and choreography; others like Satir and Whitaker rely on the spontaneity of just being themselves. Satir had a remarkable ability to communicate. Like many great therapists, she was a dynamic personality. But she didn’t rely merely on personal warmth. Rather, she worked actively to clarify communication, turned people away from complaining toward finding solutions, supported the self-esteem of every member of the family, pointed out positive intentions (long before positive connotation became a strategic device), and showed by example how to be affectionate (Satir & Baldwin, 1983). She was a loving but forceful healer. One of Satir’s hallmarks was the use of touch. Hers was the language of tenderness. She often began by making physical contact with children, as evidenced in her case “Of Rocks and Flowers.” Bob, a recovering alcoholic, was the father of two boys, Aaron (four) and Robbie (two), whose mother had abused them repeatedly—pushing them down stairs, burning them with cigarettes, and tying them up under the sink. At the time of the interview, the mother was under psychiatric care and didn’t see the children. Bob’s new wife, Betty, had been abused by her previous husband, also an alcoholic. She was pregnant and afraid that the boys would abuse the baby. The boys had already been expressing the violence they’d been exposed to—slapping and choking other children. Bob and Betty, acting out of frustration and fear, responded roughly to the boys, which only increased their aggressiveness. Throughout the session, Satir showed the parents how to touch the children tenderly and how to hold them firmly to stop them from misbehaving. When Bob started to tell Aaron something from a distance, Satir insisted on proximity and touch. She sat Aaron down in front of his father and asked Bob to take the little boy’s hands and speak directly to him. The following fragments from the session are taken from Andreas (1991).Virginia Satir focused more on helping family members connect than on the psychological and systemic forces that kept them apart. Courtesy of the Virginia Satir Global Network Case Study Those little hands know a lot of things; they need to be reeducated. OK. Now, there is a lot of energy in both these youngsters, like there is in both of you. And I am going to talk to your therapist about making some room for you to have some respite (from the children). But use every opportunity you can to get this kind of physical contact. And what I would also recommend that you do is that the two of you are clear about what you expect. And if you (Bob) could learn from Betty how to pay attention (to the kids) more quickly, I would like you to be able to get your message without a “don’t” in it—and that your strength when you pick them up—I don’t know if I can illustrate it to you, but let me have your arm for a minute (reaching for Bob’s forearm). Let me show you the difference. Pick up my arm like you were going to grab me. (Bob grabs her arm.) All right. Now when you do that, my muscles all start to tighten, and I want to hit back. (Bob nods.) Now pick up my arm like you wanted to protect me. (Bob holds her arm.) All right. I feel your strength now, but I don’t feel like I want to pull back like this. (Bob says, “Yeah.”)And what I’d like you to do is lots and lots of touching of both of these children. And when things start to get out of hand, then you go over—don’t say anything—go over to them and just take them (demonstrating the protective holding on both of Robbie’s forearms) but you’re not pulling them (Aaron briefly puts his hands on top of Virginia’s and Robbie’s arms) like this (demonstrating), but you are taking them in a strong way (stroking Bob’s arm with both hands), like you saw the difference.(Virginia turns to Betty and offers her forearm.) OK. Now I’d like to do the same with you. So, take my arm really tight. . . . (Betty grabs Virginia’s arm, and Aaron does, too.) Yeah, that’s right, like you really wanted to give me “what for.” OK. All right. Now give it to me like you want to give me support, but you also want to give me a boundary. So the next time you see anything coming, what you do is you go and make that contact (Virginia demonstrates by holding Aaron’s upper arm.) and then let it go soft. Now, Aaron, I’d like you to come up here so I could demonstrate something to your mother for a minute. (Aaron says, “OK.”) Now, let’s suppose some moment I’m not thinking and I take you like that (grabbing Betty’s arms suddenly with both hands). You see what you want to do? (Betty nods.) All right. Now I am going to do it another way. I am giving you the same message (Virginia holds Betty’s arm firmly with both hands, looking directly into her eyes, and starts to stand up.), but I am doing it like this. And I am looking at you, and I’m giving you a straight message. OK. Now your body at that point is not going to respond negatively to me. It is going to feel stopped, but not negative. And then I will take you like this. (Virginia puts one arm around Betty’s back and the other under her upper arm.) Just like this (Virginia puts both arms around Betty and draws her close.) and now I will hold you. I will hold you like that for a little bit. Following this session, Satir commented on her technique: There had been so many things happening, and the fear was so strong in relation to these children that if you thought of one image it was like they were monsters. So one of the things that I wanted to do was also to see that they had the capacity to respond with a touch, using myself in that regard by having them put their hands on my face—that was a kind of mirror for the family itself, the people in the family. And then allowing them, and encouraging them to do that with their own parents. See, touch, that comes out of the kind of ambience which was there at the time, says things no words can say. To encourage empathy and bring family members closer together, Satir often used the following exercise (adapted from Satir & Baldwin, 1983):Think of a difficult situation with your child. Perhaps your child has been doing something that you haven’t known how to handle or that drives you up the wall. Run your movie of this situation from your own point of view. Imagine you are going through this situation with your child again. Notice how you feel, what you see, what you hear. Re-experience this situation, but this time as your child. Visualize the entire situation slowly and in detail, as you would imagine seeing it through the eyes of your child. Let yourself feel what your child must be feeling. Do you notice any feelings that you weren’t aware your child might be having? Do you notice something that your child might need or want that you hadn’t been aware of? Re-experience the same situation, this time as an observer. Watch and listen to what’s happening, and allow yourself to observe both your child and yourself. Do you notice anything about the way you and your child respond to each other? What do you see more clearly about yourself and your child? Because Whitaker favored a personal encounter over a calculated approach, it’s not surprising that his style was the same with individuals, couples, and groups (Whitaker, 1958). He assiduously avoided directing real-life decisions, preferring instead to open family members up to their feelings and join them in their uncertainty. This may sound trite, but it’s an important point. As long as a therapist (or anyone else for that matter) is anxious to change people, it’s hard, very hard, to help them feel understood—and even harder to really empathize with them. A comparison between Whitaker’s early (Whitaker, 1967; Whitaker, Warkentin, & Malone, 1959) and later work (Napier & Whitaker, 1978) shows how he changed over the years. He started out as deliberately outlandish. He might fall asleep in sessions and then report his dreams; he wrestled with patients; he talked about his own sexual fantasies. In later years he was less provocative. This seems to be what happens to therapists as they mature; they have less need to impose themselves and more willingness to listen. Because Whitaker’s treatment was so intense and personal, he believed that two therapists should work together. Having a co-therapist to share the burden keeps therapists from being absorbed in the emotional field of a family. Family therapy tends to activate therapists’ own feelings toward certain types of family members. A detached, analytic stance minimizes such feelings; emotional involvement maximizes them. The trouble with countertransference is that it tends to be unconscious. Therapists are more likely to become aware of such feelings after sessions are over. Easier still is to observe countertransference in others. Consider the example of Dr. Fox, a married man who specializes in individual therapy but occasionally sees married couples. In 75 percent of such cases, Dr. Fox encourages the couple to seek a divorce, and his patients have a high rate of following his advice. Perhaps if Dr. Fox were happier in his own marriage or had the courage to change it, he’d be less impelled to guide his patients where he fears to go. To minimize countertransference, Whitaker recommended sharing feelings openly with families. If feelings are openly expressed they’re less likely to be acted out. Whitaker’s first sessions (Napier & Whitaker, 1978) were fairly structured, and they included taking a family history. For him, the first contacts with families were opening salvos in “the battle for structure” (Whitaker & Keith, 1981). He wanted the family to know that the therapist was in charge.1 This began with the first telephone call. Whitaker (1976b) insisted that the largest possible number of family members attend; he believed that three generations were necessary to ensure that grandparents would support, not oppose, therapy and that their presence would help correct distortions. If significant family members wouldn’t attend, Whitaker generally refused to see the family. Why begin with the cards stacked against you? 1 We might add that there is a big difference between trying to control the structure of sessions and trying to control people’s lives. Along with Satir, Whitaker was among the foremost exponents of the therapist’s use of self as a catalyst for change. But whereas Satir offered a warm, supportive presence, Whitaker was at times blunt, even confrontational. Actually, the provocative interventions of someone like Whitaker only become acceptable to families after the therapist has proven to be an understanding and caring person. Before challenging people, it is first necessary to win their trust. Regardless of whether they are provocative or supportive, experiential therapists are usually quite active. Instead of leaving family members to work out their own issues with each other, they say “Tell him (or her) what you feel!” or ask “What are you feeling right now?” Just as the best way to get a school teacher’s attention is to misbehave, the best way to get an experiential therapist’s attention is to show signs of emotion without actually expressing it. Case Study Therapist: I see you looking over at dad whenever you ask mom a question, what’s that about? Kendra: Oh, nothing . . . .Therapist: It must mean something. Come on, what were you feeling? Kendra: Nothing! Therapist: You must have been feeling something. What was it? Kendra: Well, sometimes when mom lets me do something, dad gets mad. But instead of yelling at her, he yells at me (crying softly).Therapist: Tell him. Kendra: (angrily, to the therapist) Leave me alone! Therapist: No, it’s important. Tell your Dad how you feel. Kendra: (sobbing hard) You’re always picking on me! You never let me do anything! Experiential therapists use a number of expressive techniques in their work, including family sculpting (Duhl, Kantor, & Duhl, 1973), family puppet interviews (Irwin & Malloy, 1975), family art therapy Experiential therapists encourage emotional expression as a vehicle for change. Creativa/Fotolia(Geddes & Medway, 1977), conjoint family drawings (Bing, 1970), and Gestalt therapy techniques (Kempler, 1973). Among the accoutrements of experiential therapists’ offices are toys, dollhouses, clay, teddy bears, drawing pens and paper, and batacca bats. In family sculpting, the therapist asks one member of a family to arrange the others in a tableau. This is a graphic means of portraying each person’s perceptions of the family and his or her place in it. This was a favorite device of Satir, who frequently used ropes and blindfolds to dramatize the constricting roles family members trap each other into (Satir & Baldwin, 1983).The following example of sculpting occurred when a therapist asked Mr. N. to arrange the members of his family into a scene typical of the time when he comes home from work. Case Study Mr. N.: When I come home from work, eh? Okay (to his wife) honey, you’d be by the stove, wouldn’t you? Therapist: No, don’t talk. Just move people where you want them to be. Mr. N.: Okay. He guided his wife to stand at a spot where the kitchen stove might be and placed his children on the kitchen floor, drawing and playing. Therapist: Fine, now, still without any dialogue, put them into action. Mr. N. then instructed his wife to pretend to cook but to turn frequently to see what the kids were up to. He told the children to pretend to play for awhile but then to start fighting and complaining to mommy. Therapist: And what happens, when you come home? Mr. N.: Nothing. I try to talk to my wife, but the kids keep pestering her, and she gets mad and says to leave her alone. Therapist: Okay, act it out .Mrs. N. acted out trying to cook and referee the children’s fights. The children, who thought this a great game, pretended to fight and tried to outdo each other getting mommy’s attention. When Mr. N. “came home,” he reached out for his wife, but the children came between them, until Mrs. N. finally pushed all of them away. Afterwards, Mrs. N. said that she hadn’t realized her husband felt ignored. She just thought of him as coming home, saying hello, and then withdrawing into the den with his newspaper and a bottle of beer. Family sculpting is also used to illuminate scenes from the past. A typical instruction is, “Remember standing in front of your childhood home. Walk in and describe what typically happened.” The idea is to make a tableau portraying one’s perceptions of family life. It’s a device to focus awareness and heighten sensitivity. Peggy Papp and her colleagues at the Ackerman Clinic (Papp, Scheinkman, & Malpas, 2013) introduce sculpting by asking couples if they’re willing to try a playful way to communicate their feelings about their relationship. If the couple agrees, the therapist asks them to close their eyes and relax. Once they are relaxed, they’re told to think about the main problem in their relationship and the feelings that emerge. After they’ve gotten in touch with their feelings, the therapist asks them to imagine what symbolic forms each of them would take (e.g., David and Goliath, a cop and a criminal, fire and ice) and then imagine what movement between these forms might be as they are trying to deal with the problem between them. “How would they interact?” “Where would this take place? In a meadow, the living room, a circus?” “What is impasse between the two forms?” “What are the solutions that each of them tries that don’t work?” “Do they try anything else?” “What is your greatest fear if the problem is never solved?” “What is your best hope?” “What would be an ideal way for the two forms to interact?” Then the therapist has the couple open their eyes and each partner in turn directs the pantomime and tells the partner what to do. Case Study Papp and her colleagues describe the use of sculpting in a couple who had gone from having sex several times a week to once a month. In the sculpting exercise Jack saw himself as a sponge and Diane as a bottle of water. Try as he might, the sponge could not open the bottle of water. He imagined that if the sponge never got the bottle of water to open up he would dry up and die. Diane’s fantasy was that she was a column of ice and Jack, in his eager pursuit of her, was like a blazing fire that frightened her. Using the couple’s own images, the therapist suggested that Jack experiment with other ways of melting the ice other than being a passive sponge or a raging fire. She asked Diane to imagine other forms that water might take, like a sparkling brook, an elegant fountain, or a splashing waterfall. Imagining these alternative images helped each of the partners consider new ways of approaching and reacting to each other. In imagining a new way to approach Diane, Jack remembered that she always seemed more relaxed when he helped out around the house. Diane acknowledged her resentment of the uneven division of labor and how this resentment had interfered with her sexual desire. Diane’s imagining herself as a more active form of water, helped her feel less passive and threatened by Jack’s “fire.” Another expressive exercise is family art therapy. Kwiatkowska (1967) instructs families to produce a series of drawings, including a “joint family scribble,” in which each person makes a quick scribble and then the whole family incorporates the scribble into a unified picture. Bing (1970) describes the conjoint family drawing as a means to warm families up and free them to express themselves. In this procedure families are told to “draw a picture as you see yourselves as a family.” The resulting portraits may disclose perceptions that haven’t previously been discussed, or the task may stimulate the person drawing the picture to realize something that he or she had never thought of before. Case Study A father drew a picture of the family that showed him off to one side, while his wife and children stood holding hands. Although he was portraying a fact well-known to his wife and himself, they hadn’t spoken openly of it. Once he showed his drawing to the therapist, there was no avoiding discussion. In another case, when the therapist asked each of the family members to draw the family, the teenage daughter was uncertain what to do. She had never thought much about the family or her role in it. When she started to work, her drawing just seemed to emerge. She was surprised to discover that she’d drawn herself closer to her father and sisters than to her mother. This provoked a lively discussion between her and her mother about their relationship. Although the two of them spent time together, the daughter didn’t feel close because she thought her mother treated her like a child, never talking about her own concerns, and showing only superficial interest in the daughter’s life. For her part, the mother was surprised, and not at all displeased, that her daughter felt ready to establish a relationship on a more mutual, caring basis. In family puppet interviews, Irwin and Malloy (1975) ask one of the family members to make up a story using puppets. This technique, originally used in play therapy, is designed to highlight conflicts and alliances. Puppets also provide a safe avenue for symbolic communication. For example, a child who has used a specific puppet to symbolize his anger (e.g., a dinosaur) may simply reach for the dinosaur whenever he feels threatened. Diana Arad recently developed the animal attribution storytelling technique, which requires family members to choose animals to represent all the members of the family and then tell a story about the animal protagonists. The following case study from Arad (2004) illustrates the application of this technique in a family with an aggressive, acting-out nine-year-old. Case Study Sara and Jacob Cohen came to therapy with their daughter Dana (four) and son Roy (nine), who was diagnosed with oppositional defiant disorder. Roy was aggressively rebellious, wet his bed, and alternated between depression and angry outbursts in which he said he wished he were dead. He also showed extreme sibling rivalry with his little sister and frequently punched her during arguments. Roy entered the office for the first session firmly in his father’s grasp. He’d been crying and was determined not to cooperate. The therapist assured him that he wasn’t going to be forced to do anything and that he didn’t have to participate if he didn’t want to. When the therapist introduced the animal storytelling game, she began by asking Dana, the youngest member of the family, to begin (to prevent her from copying other family members’ stories). “If your mother were an animal,” the therapist asked Dana, “what animal would she be? ”Dana replied that her mother would be a horse, her father a squirrel, her brother a chicken, and herself a wolf. When asked to make up a story about these animal characters, Dana related the following: Once upon a time, a horse went to visit his friend the chicken. At the same time, a wolf came to eat the chicken, but the horse saved the chicken. Then the squirrel took the chicken and the horse to visit him under his tree and made the chicken laugh. What this story revealed was that four-year-old Dana, who was seen as the good child and her brother’s victim, saw herself (wolf) as an aggressor to her brother (chicken) and as an outsider to the family interaction (not invited to the fun under the squirrel’s tree). Her parents were extremely surprised by this portrayal of the family. When she was asked for an example of acting like a wolf, Dana described how when Roy used the computer, she would watch from the door and then “attack” his mouse-using hand and run to her mother. Roy would chase her, “clucking” like a chicken, but he couldn’t retaliate because Dana was protected by mother. Roy usually shouted and raged and then got punished, leaving the computer free for Dana to use. Here’s Roy’s story: Once upon a time, when an elephant (dad) went for a walk in the jungle, he stepped on a cockroach (Dana). The cockroach got squished, but the elephant did not notice and went on his way. A cat (Roy) came, found the squished cockroach, and thought it was a Frisbee. He took it to his friend the dog (mom) in order to play with it. They played Frisbee with it until they were fed up and threw it back to where the cat had found it. The elephant came back, took the squished cockroach, and ate it. The cockroach recovered and ran around inside the elephant. This tickled him so that he burst out laughing, expelling the cockroach through his mouth so hard that it landed in the same place where he was stepped on before. Then one day, the elephant went for a walk again and stepped on it again. Both children’s stories portrayed the father as a disengaged figure—a funny squirrel who appears after the danger is gone and a passing elephant who does damage without even noticing. This picture, which did not match the family’s official version of the father as loving and involved, was also reflected in the mother’s story, in which the father was represented as a mischievous but unapproachable dolphin. The children’s stories helped the parents to see Roy in a different light. They agreed that when Roy started raging, cursing, and throwing things, they would consider it “clucking like a chicken,” and they would keep their distance. Moreover, the parents took the children’s perspectives into account and stopped blaming Roy for all the fights. They decided to enforce equal consequences when the children fought. They were both sent to time out—“just in case the wolf was at it again.” Roy thought this was fair, and sibling rivalry decreased considerably. Eliana Gil (1994) describes a number of play therapy techniques and explains how they can be used to engage young children in family treatment. In the typical day interview, Gil asks children to pick days of the week and select dolls (or puppets) to represent the people in their families. Then the therapist asks the children to use the figures to show where people are and what they do throughout the day. Gil recommends asking specifically about television watching, eating habits, sleeping habits, hygiene, anger, and affection. One ten-year-old who had described everything in his house as fine responded to a question about what he watched on television after school by listing twelve shows, ending with David Letterman. When the therapist asked, “What happens after you watch Letterman?” the boy replied, “I go to sleep.” “Who’s at home when you go to sleep?” “No one” (Gil, 1994).Role-playing is another favorite device. Its use is based on the premise that experience, to be real, must be brought to life in the present. Recollection of past events and consideration of hoped-for or feared future developments can be made more immediate by role-playing them in a session. Kempler (1968) encourages parents to fantasize and role-play scenes from childhood. A mother might be asked to role-play what it was like when she was a little girl, or a father might be asked to imagine himself as a boy caught in the same dilemma as his son. When someone who isn’t present is mentioned, therapists may introduce the Gestalt empty chair technique (Kempler, 1973). If a child talks about her Susan Johnson’s focus on emotional longings can be seen as an antidote to the field’s current preoccupation with cognition. Courtesy of Susan Johnson grandfather, she might be asked to speak to a chair, which is used to personify grandfather. Whitaker (1975) used a similar role-playing technique, which he called “psychotherapy of the absurd.” This consists of augmenting the unreasonable quality of a patient’s response to the point of absurdity. It often amounts to calling a person’s bluff, as the following example illustrates: Patient: I can’t stand my husband! Therapist: Why don’t you get rid of him, or take up a boyfriend? At times this takes the form of sarcastic teasing, such as mock fussing in response to a fussy child. The hope is that patients will get objective distance by participating in the therapist’s distancing; the danger is that patients will feel hurt at being made fun of. These techniques have proven useful in individual therapy (Nichols & Zax, 1977) to intensify emotional experiencing by bringing memories into focus and acting out suppressed reactions. Whether such devices are necessary in family therapy is open to question. In individual treatment patients are isolated from the significant figures in their lives, and role-playing may be useful to approximate being with those people. But because family therapy is conducted with significant people present, it seems doubtful that role-playing or other means of fantasy are necessary. If emotional action is wanted, plenty is available simply by opening dialogue between family members. Two recent experiential approaches to family therapy that represent a more sophisticated understanding of family dynamics are emotionally focused couples therapy and the internal family systems model. Emotionally Focused Couples Therapy Emotionally focused couples therapy works on two levels in succession—uncovering the hurt and longing beneath defensive expressions of anger and withdrawal and then helping couples understand how these feelings are played out in their relationship. To begin with, the therapist acknowledges each client’s immediate feelings—hurt and anger, say—to make them feel understood (Johnson, 1998). Watch this video of Dr. Susan Johnson explain emotionally focused couples therapy. What is your favorite aspect of her approach?www.youtube.com/watch? v=xQCg-jC25fo Case Study “You’re getting angrier and angrier. It’s upsetting for you to hear Will picture himself as innocent, isn’t it?” By interrupting a couple’s quarrel and reflecting what each of them is feeling, the therapist defuses hostility and helps them focus on their experience, rather than on each other’s crimes. Then, to explore the perceptions that underlie the partners’ emotional responses to each other, the therapist asks for a description of what happens at home. “Oh, so part of you believes him, but part of you is suspicious?” “Part of you is watching and expecting that he’ll hurt you?” “Can you tell me about the part that believes he’s being honest?” Next the therapist points out how the couple’s emotions are driving them into cycles of escalating polarization. The cycle was formulated in terms of Will’s protecting himself by staying distant and avoiding Nancy’s anger, and Nancy’s being vigilant and fighting to avoid being betrayed again. As she became more insecure and distrustful, Will felt more helpless and distanced himself further. As he distanced, she felt betrayed and became more enraged. Both were framed as victims of the cycle, which I continually framed as a common problem that the partners need to help each other with (Johnson, 1998, pp. 457–458).The couple’s growing awareness of how their emotional reactivity frustrates their longings sets the stage for uncovering and expressing the deep emotions that lie beneath their sparring. The resulting cathartic expression makes it possible for the couple to deepen their understanding of their destructive pattern with each other, and this circular process continues to be explored in the process of working through. Attachment theory helps the emotionally focused couples therapist pinpoint the issues that get stirred up when couples talk about their hurts and longings. “Maybe you feel like no one really loves you?” “You feel helpless and alone, don’t you?” The impact of this emotional evocation is enhanced by the fact that the partner is present to be addressed in this new and more compassionate way. “So, can you tell her that?” The ultimate aim of this work is to enable the partners to risk being vulnerable with each other by acknowledging and expressing their attachment needs. “Only you can face your fear and decide to risk depending on Will. He can’t do it, can he? The only one who can drop your defenses and risk trusting him is you, isn’t it?” “What’s the worst thing that could happen?” Again, working together with the couple means that once the partners risk expressing their needs and fears, their mates can be encouraged to respond. “What happens to you, Will, when you hear this?” The response to this question will of course be very different once the partners let down their guard and begin to talk about what they’re afraid of and what they really want from each other. The therapist frames couples’ experiences in terms of deprivation, isolation, and loss of secure connectedness. This perspective, from attachment theory, helps family members focus on their longings rather than on each other’s faults and failings. What attachment theory adds is an understanding of how children whose caregivers were emotionally unresponsive develop an insecure attachment (Bowlby, 1988). They come to believe that other people can’t be depended on, and when their emotional security is threatened in adult romantic relationships they try to restore emotional comfort by either frantically pulling their partner closer (as is common with anxious attachment) or become distant and aloof in an effort to not need their partner and therefore not feel hurt by their rejection (a pattern common to avoidant attachment). A common pursue/withdraw pattern emerges wherein one partner pursues closeness while the other withdraws emotionally. Even though the underlying motivation for each partner is to establish emotional security, their attachment fears of rejection or abandonment lead them to act in a way that pushes their partner away, thus giving each of them less of what they long for (Johnson, 2004). Their solution has become the problem. When attachment is threatened, a person initially feels primary emotions—“soft” emotions such as sadness, fear, hurt, and longing. The expression of primary emotions tends to evoke compassionate responses from people. But a person who feels unsafe expressing primary emotions, will instead express defensive, secondary emotions such as anger, contempt, or coldness. The expression of secondary emotions tends to provoke similarly distancing responses from the partner, which puts in motion a cycle where both people want closeness, but are acting in a way that produces more distance. The challenge for a therapist is to learn to see behind secondary emotions, and to help couples do the same—for example, to see anger as an attempt to modify the other partner’s inaccessibility, and to see withdrawal as an attempt to avoid risking rejection (Johnson, 2004).In short, the purpose of emotionally focused therapy is to help foster secure attachment. This is done by helping partners recognize their primary attachment needs, express those needs to their partner openly and directly, and to recognize and respond to their partner’s attachment needs. As this happens, healing interactional cycles form, deep-seated views of the self as unlovable and needs as being shameful shift, and individuals become more secure. For example, say a couple argues over the frequency of sex. The pursuer may want sex to reassure his or her fears of rejection. The distancer may reject sex, or participate grudgingly, as a means of not getting too close or of being overwhelmed by their fears. Once the frequency of sex no longer symbolizes attachment fears, it is much easier for the couple to agree on the frequency of sex (or whatever their conflict may be).As the name suggests, emotionally focused therapy is experiential, not analytic or didactic. In contrast to the more free-wheeling experiential approaches of Whitaker and Satir, however, emotionally focused therapy outlines nine steps divided across three broad stages, with interventions associated with each step (Johnson, Bradley, Furrow, Lee, Palmer, Tilley, & Woolley, 2005). The stages and steps are: Stage 1:Cycle De-escalation Assessment Identify negative interactional cycle(s)Access unacknowledged emotions Reframe problems in terms of attachment needs Stage 2:Changing Interactional Positions Promote identification with disowned needs Promote acceptance of partner’s experience Facilitate expression of needs and wants Stage 3:Consolidation and Integration Emergence of new solutions to old problems Consolidate new positions and attachment cycles In all of these steps the therapist moves between helping partners uncover and express their emotional experience and helping them reorganize the pattern of their interactions. For example: The therapist might, then, first help a withdrawn, guarded spouse formulate his sense of paralyzed helplessness that primes his withdrawal. The therapist will validate this sense of helplessness by placing it within the context of the destructive cycle that has taken over the relationship. The therapist will heighten this experience in the session and then help his partner to hear and accept it, even though it is very different from the way she usually experiences her spouse. Finally, the therapist moves to structuring an interaction around this helplessness, as in, “So can you turn to her and can you tell her, ‘I feel so helpless and defeated. I just want to run away and hide.’ ” This kind of statement, in and of itself, represents a move away from passive withdrawal and is the beginning of active emotional engagement. (Johnson, Hunsley, Greenberg, & Schindler, 1999, p. 70)Internal Family Systems Therapy In the internal family systems model (Schwartz, 1995, 2001), conflicting inner voices are personified as subpersonalities or “parts.” What makes this device powerful is that when family members are at odds with each other, their conflicts are often based on polarizations of only part of what they feel. The truth is that people in conflict with each other are also often in conflict within themselves. The adolescent’s defiance and her parents’ distrust are only one aspect of the complex feelings they have for each other. Or to choose a different example, a couple caught in a pursuer–distancer pattern may be acting out only those parts of them that are terrified of abandonment and engulfment. By dramatizing the elements of their inner conflicts, internal family systems therapy helps family members sort out their feelings and reconnect with each other in less polarized ways. To help clients begin to distinguish among their conflicting inner voices, Schwartz begins by introducing the language of parts. Case Study “So there’s a part of you that gets upset and angry when your son gets down on himself. Do you think that if that part didn’t get so stirred up, it would be easier for you to help him?” “It sounds like part of you agrees with your husband about getting stricter with the kids, but there’s another part that says he’s being too harsh. What is that second part? What does it say to you? What is it afraid of?” By listening carefully to what clients are feeling and then construing their reactions as coming from a part of them, the therapist initiates a shift in family polarizations. It’s easier for people to acknowledge that “a part of them” feels—angry, helpless, or whatever—than that “they” (as in all of them) feel that way. A parent who has trouble admitting that he’s angry at his son for not doing well in school may find it easier to acknowledge that a part of him gets angry at his son’s failures—and, moreover, that the angry part gets in the way of his sympathetic part. Once the idea is introduced that various parts of family members are reacting to each other, instead of seeing themselves intrinsically at odds, they can begin to see that parts of one are triggering parts of another. The obvious implication is that if their aggravating emotions are contained in only parts of them, they have other feelings and other possibilities for interaction. Thus: “So that angry part of your father seems to trigger a sad and helpless part of you, is that right?” And since many such polarizations become triangles, it might be that the father’s angry part also triggers a protective part in his wife. “So when you see your husband’s angry part responding to your son, that triggers a protective part in you? A part of you feels that you need to fight your husband to protect your son? ”So instead of having a son who is a failure, a father who is unsympathetic, and parents who can’t agree, the family discovers that each of them is having trouble with some of their parts. The father is transformed from a tyrant to a parent struggling with a frustrated and angry part of him. His wife ceases to be basically at odds with him and instead is seen as having a protective part that gets triggered by his angry part. And instead of being a failure, the son becomes a boy with a part of him that feels helpless in the face of his father’s angry part and his parents’ conflict. Like all experiential models, internal family systems therapy is founded on the belief that underneath people’s emotionally reactive parts lies a healthy core self. When the therapist notices various parts taking over, he or she asks the person first to visualize them, and then help them to calm down. If, for example, an angry part were seen as a snarling dog, that person might find that she could calm her anger by imagining reassuring the dog and petting it until it felt safe and settled down. Or to use another example (cited by Schwartz, 1998), if a frightened part were conceived as a rag doll, the client might relax her fears by imagining holding and comforting that doll. Thus, by personifying people’s polarizing emotional reactions as parts and then helping them visualize and reassure these reactive parts, internal family systems therapy releases people from the domination of fear and anger, which in turn allows them to work together more effectively to solve personal and family problems.

Evaluating Therapy Theory and Results

Experiential therapy helps family members get beneath the surface of their interactions to explore the feelings that drive them. At its best, this approach helps people drop their defenses and come together with more immediacy and authenticity. Given our contemporary emphasis on behavior and cognition, the effort to help clients uncover the feeling side of their experience is surely a welcome addition. Regardless of what approach to family therapy one takes, shifting to individuals and their experience is a good way to break through defensive squabbling. When family members argue, they usually lead with their defenses. Instead of saying “I’m hurt,” they say “You make me mad.” Instead of admitting they’re afraid, they criticize each other. An effective way to interrupt the unproductive escalation of arguments is to explore the feelings of the participants, one at a time. By talking to individuals about what they’re feeling—and the roots of such feelings—family members can be helped to get past the defensiveness that keeps them apart and to reconnect on a more genuine level. However, just as approaches that focus entirely on families and their interactions leave something out, so too does an approach that concentrates too narrowly on individuals and their emotional experience. At the peak of their popularity in the 1970s, experiential therapists approached family therapy as if it were an encounter group for relatives. They put great faith in the value of emotional experiencing and had limited appreciation of the role family structure plays in regulating that experience. Not surprisingly, therefore, as family therapy focused more on organization, interaction, and narrative in the 1980s and 1990s, the experiential model fell out of favor. As we have already suggested, a therapy designed primarily to elicit feelings may be more suited to encounter groups than to family therapy. However, the prevailing behavioral and cognitive models of family therapy could do with a little more attention to people’s feelings. If “more attention to people’s feelings” sounds a little vague, allow us to make it more concrete. Helping family members get in touch with their feelings accomplishes two things: It helps them as individuals discover what they really think and feel—what they want and what they’re afraid of—and it helps them as a family begin to relate to each other in a more honest and immediate way. Two particularly creative approaches to helping individuals get in touch with their inner experience are emotionally focused couples therapy and internal family systems therapy. What sets Johnson and Greenberg’s therapy apart is its combination of emotional expressiveness and attention to the dynamics of interaction between couples. Emotionally focused couples therapy begins, as all emotive approaches do, by exploring the feelings clients come in with—even, or especially, if those feelings are defensive. You don’t get beneath the surface of what people are feeling by ignoring it. The combination of uncovering deeper and more vulnerable emotions and teaching couples about the reactive patterns their feelings drive them through creates a meaningful cognitive experience. As Lieberman, Yalom, and Miles (1973) demonstrated with encounter groups, an emotionally intense therapeutic experience only brings lasting value when paired with an intellectual understanding of the significance of those emotions. The only caveat we might offer is that explanations are most useful following an emotionally significant process of uncovering—which is what distinguishes psychotherapy from a conversation with your Aunt Harriet. Emotionally focused couples therapy maintains that relationship difficulties generally stem from the disowning of attachment needs, creating defensive interactional cycles and ineffective communication patterns. The model identifies these issues and destructive cycles, helps clients acknowledge the feelings underlying these cycles, encourages empathy for the partner’s position, and encourages couples to communicate needs and emotions more effectively in the spirit of generating solutions and increasing intimacy. Schwartz’s internal family systems approach helps family members come together with more understanding by helping individuals sort out their own conflicted experience. Personifying unruly emotions as “parts” is a powerful device for helping people achieve a clarifying distance from their conflicts. Unlike emotionally focused therapy, internal family systems therapy does not lean heavily on didactic explanations. In this approach, emotional experiencing is clarified by learning to differentiate among one’s own feelings rather than by explanations offered by a therapist. Emotionally focused couples therapy has received a good deal of empirical support (e.g., Johnson, 2003; Johnson, Maddeaux, & Blouin, 1998; Johnson, Hunsley, Greenberg, & Schindler, 1999; Denton, Burleson, Clark, Rodriguez, & Hobbs, 2000). Specifically, recent studies have suggested that emotionally focused couples therapy helps to alleviate marital distress, as well as promote trust and forgiveness (Greenberg, Warwar, & Malcolm, 2010). Emotionally focused couples therapy is also a promising treatment for couples who are experiencing marital distress and the female partner is suffering from symptoms of major depression (Dessaulles, Johnson, & Denton, 2003). More recently, proponents of emotionally focused therapy have suggested its potential utility for couples facing breast cancer (Tie & Poulsen, 2013) and terminal illness (Adamson, 2013). One controlled randomized trial did show that couples facing end-stage cancer who participated in emotionally focused therapy reported improved marital function and patient perceived caregiver empathy (McLean, Walton, Rodin, Epslen, & Jones, 2013).Recently, researchers seeking to study the effectiveness of experiential techniques have followed Mahrer’s (1982) suggestion to focus on the process, rather than the outcome, of therapy. Because he believed that studies of outcome have little impact on practitioners (who already know that what they do works), Mahrer recommended studying in-therapy outcomes—that is, what kinds of interventions produce desired results (emotional expression, more open communication) within sessions. Following Mahrer (1982) and others (Pierce, Nichols, & DuBrin, 1983) who looked at such in-therapy outcomes in individual treatment, Leslie Greenberg and Susan Johnson have found that helping an angry and attacking partner to reveal his or her softer feelings characterizes the best session of successful cases (Johnson & Greenberg, 1988) and that intimate self-disclosure leads to more productive sessions (Greenberg, Ford, Alden, & Johnson, 1993).Once feeling-expression occupied center stage in psychological therapies; today that place is held by behavior and cognition. Psychotherapists have discovered that people think and act, but that doesn’t mean we should ignore the immediate emotional experience that is the main concern of experiential family therapy.